Chronic Pain Syndrome Flashcards
Pain caused by a stimuli that threaten or result in bodily tissue damage
Nociceptive pain
1) Pain resulting from maladaptive response to damage or pathology of the somatosensory nervous system
2) Can occur in absence of active stimuli or as an exaggerated response to minor or moderate stimuli
Neuropathic pain
Reduced ability of the CNS to diminish responses to peripheral stimuli
Centralized pain
What pain affects all aspects of life from family life to employment
Chronic pain
(1) Unpleasant sensory and emotional experience associated with actual or potential tissue damage
(2) Pain is experienced in developmental, social and emotional context therefore evaluation of patients with chronic pain requires a search for a biomedical cause, psychologic and social evaluation and assessment of physical function and sleep
(3) Chronic pain is defined as an acutely painful condition that persists beyond the usually expected 6-12 week time course for healing
What is pain?
What pain is characterized by what we traditionally recognize as a pain that is caused by a physical stimuli
Nociceptive pain
What pain is most commonly described as tingling, pins and needles, burning, shooting electric like shocks
Neuropathic pain
(1) Thorough evaluation includes:
(a) Past medical and surgical hx
(b) Review of systems
(c) Social and family hx
(d) Psychiatric hx
(e) Pain assessment: Hx of pain, location, characteristics, severity and impact of
daily life***
Patient evaluation: Chronic Pain Syndrome.
Imaging may be useful when pain is in a specific site of bone or joint
Imaging: Chronic Pain Syndrome.
(1) Initial management is with non-pharmacologic therapies
(a) Home exercise programs
(b) Physical therapy
(2) Psychological approaches especially for patients with mood, sleep, quality of life or
interpersonal relationship issues
(a) Cognitive behavioral therapy (CBT)
(b) Mindfulness therapy
(3) Other treatment
(a) Acupuncture
(b) Spinal manipulation with osteopathic manipulation therapy or chiropractic care
(c) Transcutaneous nerve stimulation (TENS)
Management and treatment of chronic pain
(a) Medications that inhibit pain transmission
1) Tylenol
2) NSAID
3) Capsaicin
(b) Medications that inhibit descending pain modulation
1) Gabapentin
2) Tricyclic antidepressants
3) SNRIs
Medications for chronic pain
(a) Patients should be educated on realistic expectations for response
(b) Chronic pain Is rarely fully eliminated but often can be reduced
1) On average there is a 30% reduction in pain which can help to improve quality of life and function
(c) Important to give reassurance and have proper follow up with this patient population
Important to set patient expectations for chronic pain
